PUG RESCUE & ADOPTION VICTORIA INC.

PO Box 4802, Knox City Centre, Vic, 3152

0488784497
info@pugrescue.org.au
www.pugrescue.org.au

Date:
Names of
family
members:
Address:

Suburb/
State: Post Code:
Phone: Work: Mobile:
Email:

How did you hear about us?

1. Which Pug are you applying for? (We generally prefer that applicants apply for a particular pug)
Pugs name: Help me choose a Pug

2. What gender Pug do you prefer?

Male Female No preference

Please explain your choice:

3. What colour Pug do you prefer?

Fawn Black No preference

4. What age Pug do you prefer?

2 months to 1 year 1 year to 3 years 3 years to 5 years
5 years to 7 years 7 years +

Please explain your choice: (Remember that age is just a number and that young pugs are very
active and full of mischief whilst older can be still very active, cheeky and full of energy and
love )

5. How many Pugs would you like to adopt? (In general pugs do better with another pug and
we only occasionally adopt pugs into homes where they will be a single pug/dog, this will be
specified on their adoption profile)

PUG RESCUE & ADOPTION VICTORIA INC. is a registered animal welfare charity organisation
PUG RESCUE & ADOPTION VICTORIA INC. 2013
 PUG RESCUE & ADOPTION VICTORIA INC.
Adoption Application

One (1) Two (2) Three or more

6. Would you consider adopting a Pug that has sustained an injury or who suffers from an
existing illness or disability? (Think carefully about your answer. Can you afford to financially and
physically look after an ill or disabled Pug? Could you deal with the heartbreak if the Pug did not live
long? However, this can also be a very rewarding experience knowing you have given a special Pug a
last chance at real love and happiness can be very fulfilling).
Yes No Depends on the illness/disability

7. Would you consider a cross breed Pug?

Yes No Depends on appearance Depends on cross

8. What are you reasons for wanting a Pug?

9. Have you read our information page entitled Is a Pug for me? located on our website. If
not please do so.
Yes No

10. Your marital status?

Single Married Long term relationship

11. Are members of your household employed?

Full-time Part-time Unemployed Stay at home parent
Pensioner Retired Student Work from home

If you are currently studying have you considered what your working hours and future living
plans will be once you graduate.

12. How many adults live in your household?

13. How many children live in your household? Their ages:

14. Which best describes your home?

Large House Small House Unit/Flat Apartment Townhouse Acreage

15. Do you:
Own Rent Live with parents
Note: If renting, attach to your application approval from your landlord that you may own a dog.

16. Do you have other pets?

Yes No
If yes, please specify type/breed/sex/age/ size (weight) personality and if they have been
desexed:

PUG RESCUE & ADOPTION VICTORIA INC. is a registered animal welfare charity organisation
PUG RESCUE & ADOPTION VICTORIA INC. 2015
 PUG RESCUE & ADOPTION VICTORIA INC.
Adoption Application

17. How many hours per day on average will your pug be without human companionship? ie on
work days
0 to 2 2 to 4 4 to 6 6+
Please explain:

18. If you work long hours or are away from your pug for long periods of time on a regular
basis do you have other alternatives to provide your pug with human companionship and
mental and physical stimulation? ie. Doggy Day Care, Grandparents pug sit, you can take your
pug/s to work with you etc (Pugs were bred to be human companions)

19. Who will care for your Pug if you go away (i.e. on holidays)?

20. What food/diet would you feed your Pug?

21. Have you previously owned a Pug?

Yes No

If you have previously owned a Pug please tell us a bit about them or if not a previous owner of
a Pug what is your knowledge of the breed?

22. What characteristics would you like in your Pug? (e.g. big, small, athletic, lap dog, dont care.)

23. Have you owned a previous dog? Please tell us a bit about it. How long did you own
youre your dog?

24. Where is the dog now?

Heaven Re-homed Still own Surrendered to a Shelter

25. Have you ever re-homed/surrendered a pet?

Yes No

If yes, please explain the circumstances:

PUG RESCUE & ADOPTION VICTORIA INC. is a registered animal welfare charity organisation
PUG RESCUE & ADOPTION VICTORIA INC. 2015
 PUG RESCUE & ADOPTION VICTORIA INC.
Adoption Application

26. Which of the following circumstances do you think justifies re-homing/surrendering a pet?

Moving house
Escaping from your yard
Too time consuming
Excessive barking
Divorce/Partnership break-up
Toilet training problems
Destructive behaviour
Fear of pet being lonely while youre away from home
Children have lost interest/no longer take responsibility
Ongoing medical problems
Coat shedding (pugs shed 365 days a year)
Financial problems
Fears for the safety of your new baby
Personality clash with your other pet

Other - please explain:

27. Do you have secure fencing? (Could a Pug escape under or over fences or get through gates?)
Yes No

Please explain: ie type of fencing, height of fencing, age of fencing, gaps, holes, missing
panels etc.

28. Approximate size of the secure fenced yard/area your Pug will have access to?

29. Do you have a doggy door?

Yes No

If not would you install one?

Yes No

30. If you do not have a doggy door do you have a suitable protected area for your pug whilst
they are outside?

Yes No

Please explain:

31. How many rooms in your home are air-conditioned?

32. If you do not have air-conditioning how do you propose to keep your pug cool during hot
weather? (Pugs cannot tolerate heat!!!)
Please explain:

33. Is your motor vehicle air-conditioned?

PUG RESCUE & ADOPTION VICTORIA INC. is a registered animal welfare charity organisation
PUG RESCUE & ADOPTION VICTORIA INC. 2015
 PUG RESCUE & ADOPTION VICTORIA INC.
Adoption Application

Yes No

34. Do you have a pool?

Yes No

Is the pool fencing Pug proof?

Yes No (Pugs are not water babies they will sink and drown!!!!!)

35. Where will your Pug be when youre not at home?

Outside Garage Inside with a dog door Laundry
Dog run Friends house Family members house Day care
Please explain:

36. Please explain where your pug will sleep and why your pug will sleep in this particular spot.
(ie. laundry, your bed, loungeroom, kennel, patio etc)

37. Would your Pug have full access to the majority of your house (inside)?
Yes No

Please explain:

38. Will your Pug be vaccinated, wormed, flead & heartwormed at the required intervals?
Yes No

39. Would you seek veterinary treatment for your Pug when required?
Yes No

40. Would you return your Pug to us if you encountered any difficulty? (We would rather you
returned the pug to us then re-home it with someone else)
Yes No

41. Do you pledge to love and care for your Pug and consider his/her needs to be of supreme
importance?
Yes No

42. Would you agree to a house and yard check by us prior to adoption?
Yes No Unsure

43. Would you object to being contacted on occasion? (We like to hear how Pugs are going in
their new homes)
Yes No Unsure

44. Is there anything else we should know in assessing your application?

5

PUG RESCUE & ADOPTION VICTORIA INC. is a registered animal welfare charity organisation
PUG RESCUE & ADOPTION VICTORIA INC. 2015
 PUG RESCUE & ADOPTION VICTORIA INC.
Adoption Application

45. Please provide details of your regular Vet clinic:

46. Please provide names and contact phone numbers for two personal referees:
(a)
(b)

Please be advised that PUG RESCUE & ADOPTION VICTORIA INC. reserves the right to seize
the Pug from your property post-adoption if it is established you have given false or
misleading information in your application OR if allegations of neglect or abuse are reported to
us or any other animal welfare agency.

Suitable applicants will be contacted by a PUG RESCUE & ADOPTION VICTORIA INC. volunteer
10 to 14 days after their submission of adoption application via email and undergo a phone
interview.
On completion of a successful phone interview a meet and greet including house and yard
check will be arranged where a PUG RESCUE & ADOPTION VICTORIA INC. volunteer will visit a
potential adopters home with the rescue pug that has been applied for. These house checks
and meet and greets generally last an hour to an hour and a half and the rescue pug then
returns to their PUG RESCUE & ADOPTION VICTORIA INC. foster home with our volunteer and
will not be left at a potential adopters home.
A decision to go ahead with an Adoption with a two week trial period will occur within 48 hours
of a house check and meet and greet with both the potential adopter and PUG RESCUE &
ADOPTION VICTORIA INC. agreeing to an adoption occurring.
PUG RESCUE & ADOPTION VICTORIA INC. reserves the right to not progress to the adoption
stage if the house check and meet and greet indicates a potential home is not suitable for the
rescue pug in question.

I, ,declare that at the time of signing this 'Adoption application' all information
provided by me is true and accurate and reflects my circumstances at the time of making this
application and I agree to PUG RESCUE & ADOPTION VICTORIA INCs terms and conditions.
Name:
(please
print) Signature: Date:

PUG RESCUE & ADOPTION VICTORIA INC. is a registered animal welfare charity organisation
PUG RESCUE & ADOPTION VICTORIA INC. 2015